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Privacy Authorization Forms

Privacy Authorization Forms (Requires Adobe Acrobat Reader )

Authorized Representative

Allows an insured to authorize someone to be their representative for receiving or accessing claim information and benefits

Authorization for Disclosure

Allows an insured to authorize Markel Insurance Company to disclose specified protected health information to another entity

Revocation of Authorization for Disclosure

Allows an insured to revoke a previous authorization for Markel Insurance Company to disclose specified protected health information to another entity